MEDICARE: J AND Y MEDICAL SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1558309484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J AND Y MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	4421 SW 75TH AVE
Second Line	:	SUITE 22
City	:	MIAMI
State	:	FL
Zip	:	33155-4444
Country	:	US
Telephone Number	:	305-260-0995
Fax Number	:	305-260-0959

Provider Business Practice Location Address
First Line	:	4421 SW 75TH AVE STE 22
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4444
Country	:	US
Telephone Number	:	305-260-0995
Fax Number	:	305-260-0959

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROGELIO RODRIGUEZ
Credential	:
Telephone Number	:	305-260-0995

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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